BMJ 1999;319:1027-1030 ( 16 October )

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Stressful life events and difficulties and onset of breast cancer: case-control study

Editorial by McGee

David Protheroe, senior registrar, a Kim Turvey, psychiatric nurse, a Kieran Horgan, consultant surgeon, b Eddie Benson, consultant surgeon, b David Bowers, medical statistician, c Allan House, senior lecturer in psychiatry. a

a Department of Liaison Psychiatry, Leeds General Infirmary, Leeds LS1 3EX, b Department of Surgery, Leeds General Infirmary, c Sub Unit of Medical Statistics, Nuffield Institute for Health, University of Leeds LS2 9PL

Correspondence to: D Protheroe, Northern Hospital, Epping, Victoria 3076 Australia dprotheroe{at}tnh.vic.gov.au

Objective: To determine the relation between stressful life events and difficulties and the onset of breast cancer.
Design: Case-control study.
Setting: 3 NHS breast clinics serving west Leeds.
Participants: 399 consecutive women, aged 40-79, attending the breast clinics who were Leeds residents.
Main outcome measures: Odds ratios of the risk of developing breast cancer after experiencing one or more severe life events, severe difficulties, severe 2 year non-personal health difficulties, or severe 2 year personal health difficulties in the 5 years before clinical presentation.
Results: 332 (83%) women participated. Women diagnosed with breast cancer were no more likely to have experienced one or more severe life events (adjusted odds ratio 0.91, 95% confidence interval 0.47 to 1.81; P=0.79); one or more severe difficulties (0.86, 0.41 to 1.81; P=0.69); a 2 year severe non-personal health difficulty (0.53, 0.12 to 2.31; P=0.4); or a 2 year severe personal health difficulty (2.73, 0.68 to 10.93; P=0.16) than women diagnosed with a benign breast lump.
Conclusion: These findings do not support the hypothesis that severe life events or difficulties are associated with onset of breast cancer.


Key messages

  • Although there is widespread belief that stress can cause cancer, research evidence is contradictory

  • Stressful life experiences are common; about two thirds of women with a breast lump experienced at least one severe life event or difficulty in the 5 years before presentation

  • Women diagnosed with breast cancer were no more likely to have experienced a severe stressor than women with a benign lesion

  • Knowledge or suspicion of the diagnosis did not influence reporting of severe life events




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Rapid Responses:

Read all Rapid Responses

Response
G Mocan
bmj.com, 18 Oct 1999 [Full text]
Perception of stress and coping styles are important
Craig Hassed
bmj.com, 3 Dec 1999 [Full text]
Methodology of Life Events Research
David Protheroe
bmj.com, 18 Jan 2000 [Full text]
personal stress
Johannes N Schilder
bmj.com, 29 Sep 2000 [Full text]
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